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Pleaserim I 1111111I0111� p t or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 7MManifest Tracking Number WASTE MANIFEST CAR000278318 1 877577266'3 F L E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Dollar General #13592 Dollar General#13592 2098008820 310 W DR MARTIN LUTHER KING JR 310 W DR MARTIN LUTHER KING JR Generator's Phone: STOCKTON, CA 95206-1763 STOCKI U.S. _ 6.Transporter 1 Company Name EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number 8,Designated Facility Name and Site Address 21St Century EMN, LLC 67 U.S.EPA ID Number 2095 Newlands Dr. East Fernley, NV 89408 Facility's Phone:7755752760 NVD980895338 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity Wt./Vol. 13.Waste Codes X UN1325, Waste Flammable solids, organic, n. o. i GF 00018 P 352 D001 s. (Sulfur), 4. 1, PG II, ERG#133 w X tJN1993, Waste Flammable liquids, n. o. s. 1 CF 00027 P 331 D001 (Alcohol), 3, PG II, ERG#128 X UN3266, Waste Corrosive Liquid, Basic, 1 CF 00010 P 122 D002 Inorganic, N.O.S. (Sodium Hydroxide, Potassium Hydroxide), 8 PG II ERG#154 4. t 14.Special Handling Instructions and Additional Information 1. 110519(F 1 a m m ab l e So l i d — L o o s epack) 2. 110518(F l a m in a b l e Liquids — Loosepack) 3. 110515(Basic Liquids, Inorganic — Loosepack) 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. General '/Offer d/Typed mine Signature Month Day Year �{ ts i ��'1�./ �-4 ��fr t- 09 12 019 _j 16.International Shipments F— ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Z Transporter signature(for exports only): Date leaving U.S.: Ce 17.Transporter Acknowledgment of Receipt of Materials w Transporter 1 Printed Typed Name Signature Month Day Year 0 Isidro Martinez 09 12 019 Transporter 2 Printed Typed Name V a ure Month Day Year 19, 18,Discrepancy G 18a.Discrepancy Indication Space ❑ QuantityYP T e ❑ ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: H 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z S2 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) UJ 1 1 li 244 3 � t T- C 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in 18 Printed/Typed Name x' Signature M In ay �Ye EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIG�44 9EDCILITY TO EPA's e-MANIFEST SYSTEM 8700-22_12v3 CAL20072032 541053278 041532722 M PD091219 SD091219